Preoperative biomarker evaluation for the prediction of cardiovascular events after major vascular surgery

Chan, William; Kingwell, Bronwyn A.; Schneider, Hans G.; Cox, Geoffrey; Natoli, A; Starr, Jennifer; Croft, Kevin D.; Dart, Anthony M.; Duffy, Stephen J.

doi:10.1016/j.jvs.2019.02.041

Cited by 7 publications

(8 citation statements)

References 46 publications

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“…47,48 NT-proBNP and hs-troponin T have also been associated with all-cause mortality in adults with PAD. [49][50][51] hs-troponin I has previously been associated with an elevated risk of stroke or death among adults with PAD undergoing major vascular surgery 52 and was strongly associated with all-cause and cardiovascular mortality in our study, particularly among adults with PAD. Incorporation of hs-troponin levels into guideline-derived atherosclerotic cardiovascular disease risk classification algorithms has been shown to improve risk classification for incident cardiovascular death, myocardial infarction, or stroke among adults with prior myocardial infarction.…”

Section: Table 3 Associations* (Or [95% Ci]) Of Clinical Categories O...supporting

confidence: 60%

Associations of Cardiac Biomarkers With Peripheral Artery Disease and Peripheral Neuropathy in US Adults Without Prevalent Cardiovascular Disease

Hicks

Wang

McDermott

et al. 2023

ATVB

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BACKGROUND: NT-proBNP (N-terminal pro-B-type natriuretic peptide), high-sensitivity cardiac troponin T (hs-troponin T), and high-sensitivity cardiac troponin I (hs-troponin I) are increasingly being recommended for risk stratification for a variety of cardiovascular outcomes. The aims of our study were to establish the prevalence and associations of elevated NT-proBNP, hs-troponin T, and hs-troponin I with lower extremity disease, including peripheral artery disease (PAD) and peripheral neuropathy (PN), in the US general adult population without known cardiovascular disease. We also assessed whether the combination of PAD or PN and elevated cardiac biomarkers was associated with an increased risk of all-cause and cardiovascular mortality. METHODS: We conducted a cross-sectional analysis of the associations of NT-proBNP, hs-troponin T, and hs-troponin I with PAD (based on ankle-brachial index <0.90) and PN (diagnosed by monofilament testing) in adult participants aged ≥40 years of age without prevalent cardiovascular disease in NHANES 1999 to 2004. We calculated the prevalence of elevated cardiac biomarkers among adults with PAD and PN and used multivariable logistic regression to assess the associations of each cardiac biomarker, modeled using clinical cut points, with PAD and PN separately. We used multivariable Cox proportional hazards models to assess the adjusted associations of cross categories of clinical categories of each cardiac biomarker and PAD or PN with all-cause and cardiovascular mortality. RESULTS: In US adults aged ≥40 years, the prevalence (±SE) of PAD was 4.1±0.2% and the prevalence of PN was 12.0±0.5%. The prevalence of elevated NT-proBNP (≥125 ng/L), hs-troponin T (≥6 ng/L), and hs-troponin I (≥6 ng/L for men and ≥4 ng/L for women) was 54.0±3.4%, 73.9±3.5%, and 32.3±3.7%, respectively, among adults with PAD and 32.9±1.9%, 72.8±2.0%, and 22.7±1.9%, respectively, among adults with PN. There was a strong, graded association of higher clinical categories of NT-proBNP with PAD after adjusting for cardiovascular risk factors. Clinical categories of elevated hs-troponin T and hs-troponin I were strongly associated with PN in adjusted models. After a maximum follow-up of 21 years, elevated NT-proBNP, hs-troponin T, and hs-troponin I were each associated with all-cause and cardiovascular mortality, with higher risks of death observed among adults with elevated cardiac biomarkers plus PAD or PN compared with elevated biomarkers alone. CONCLUSIONS: Our study establishes a high burden of subclinical cardiovascular disease defined by cardiac biomarkers in people with PAD or PN. Cardiac biomarkers provided prognostic information for mortality within and across PAD and PN status, supporting the use of these biomarkers for risk stratification among adults without prevalent cardiovascular disease.

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Section: Table 3 Associations* (Or [95% Ci]) Of Clinical Categories O...supporting

confidence: 60%

Associations of Cardiac Biomarkers With Peripheral Artery Disease and Peripheral Neuropathy in US Adults Without Prevalent Cardiovascular Disease

Hicks

Wang

McDermott

et al. 2023

ATVB

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“…Increased preoperative B-type NPs appear also to have prognostic value for mortality and poor cardiovascular outcomes. However, perioperative changes and postoperative B-type NPs for prognosis and for risk prediction are less well studied 8,9,12–14,59–108 . Current European guidelines 109,110 provide guidance on the use of cardiac biomarkers that differ in terms of strength of the recommendation and on the population to be submitted for cardiac biomarker evaluation.…”

Section: Introductionmentioning

confidence: 99%

ESAIC focused guideline for the use of cardiac biomarkers in perioperative risk evaluation

Lurati Buse,

Bollen Pinto,

Abelha

et al. 2023

European Journal of Anaesthesiology

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BACKGROUND In recent years, there has been increasing focus on the use of cardiac biomarkers in patients undergoing noncardiac surgery. AIMS The aim of this focused guideline was to provide updated guidance regarding the pre-, post- and combined pre-and postoperative use of cardiac troponin and B-type natriuretic peptides in adult patients undergoing noncardiac surgery. METHODS The guidelines were prepared using Grading of Recommendations Assessment Development and Evaluation (GRADE) methodology. This included the definition of critical outcomes, a systematic literature search, appraisal of certainty of evidence, evaluation of biomarker measurement in terms of the balance of desirable and undesirable effects including clinical outcomes, resource use, health inequality, stakeholder acceptance, and implementation. The panel differentiated between three different scopes of applications: cardiac biomarkers as prognostic factors, as tools for risk prediction, and for biomarker-enhanced management strategies. RESULTS In a modified Delphi process, the task force defined 12 critical outcomes. The systematic literature search resulted in over 25,000 hits, of which 115 full-text articles formed the body of evidence for recommendations. The evidence appraisal indicated heterogeneity in the certainty of evidence across critical outcomes. Further, there was relevant gradient in the certainty of evidence across the three scopes of application. Recommendations were issued and if this was not possible due to limited evidence, clinical practice statements were produced. CONCLUSION The ESAIC focused guidelines provide guidance on the perioperative use of cardiac troponin and B-type natriuretic peptides in patients undergoing noncardiac surgery, for three different scopes of application.

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“…However, there is increasing evidence that NEP substrates and/or products, including brain or natriuretic peptides, may serve as biomarkers or prognostic indicators following surgery of human AAAs. (Rajagopalan et al, 2008;Vetrugno et al, 2012;Bryce et al, 2013;Folsom et al, 2015;Acosta et al, 2018;Chan et al, 2019) Given these findings, it is surprising that NEP inhibition with sacubitril had no significant effects on AngII-induced AAA formation. In contrast, similar to previous findings (Daugherty et al, 2001;Iida et al, 2012), AT1R antagonism with valsartan was highly effective at reducing the formation of AngII-induced AAAs.…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, this is the first report of AngII-stimulated NEP mRNA abundance and the presence of positive NEP immunostaining in normal or aneurysmal human AAA tissue. However, there is increasing evidence that NEP substrates and/or products, including brain or natriuretic peptides, may serve as biomarkers or prognostic indicators after surgery of human AAAs ( Rajagopalan et al, 2008 ; Vetrugno et al, 2012 ; Bryce et al, 2013 ; Folsom et al, 2015 ; Acosta et al, 2018 ; Chan et al, 2019 ). Given these findings, it is surprising that NEP inhibition with sacubitril had no significant effects on AngII-induced AAA formation.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic Assessment of Combination Therapy with a Neprilysin Inhibitor and Angiotensin Type 1 Receptor Antagonist on Angiotensin II–Induced Atherosclerosis, Abdominal Aortic Aneurysms, and Hypertension

Alsiraj

Thatcher

Liang

et al. 2021

J Pharmacol Exp Ther

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Number of text pages (32), tables (1), figures (4) and references (54), the number of words in the abstract (248), introduction (654) and discussion (1339) List nonstandard abbreviations: angiotensin II (AngII), neprilysin (NEP), angiotensin type 1 receptor (AT1R), abdominal aortic aneurysms (AAAs) Recommended section assignment: CardiovascularThis article has not been copyedited and formatted. The final version may differ from this version.

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Preoperative biomarker evaluation for the prediction of cardiovascular events after major vascular surgery

Cited by 7 publications

References 46 publications

Associations of Cardiac Biomarkers With Peripheral Artery Disease and Peripheral Neuropathy in US Adults Without Prevalent Cardiovascular Disease

Associations of Cardiac Biomarkers With Peripheral Artery Disease and Peripheral Neuropathy in US Adults Without Prevalent Cardiovascular Disease

ESAIC focused guideline for the use of cardiac biomarkers in perioperative risk evaluation

Therapeutic Assessment of Combination Therapy with a Neprilysin Inhibitor and Angiotensin Type 1 Receptor Antagonist on Angiotensin II–Induced Atherosclerosis, Abdominal Aortic Aneurysms, and Hypertension

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